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Workers’ Compensation FAQ’s

Who is Eligible to Receive Workers’ Compensation Benefits? What Benefits can an Injured Employee Receive? What Should I do if My Claim is Denied?

Every year, thousands of Georgia employees are injured on the job. Fortunately, because the state requires almost all employers to purchase workers’ compensation insurance, employees who are hurt on the job are usually eligible to collect benefits.

Workers’ compensation benefits can play a crucial role in helping injured employees get back on their feet, so it is especially important for Georgia workers to be familiar with the state’s workers’ compensation laws. We’ve included a few FAQs to help get you started, but if you are looking for more in-depth information or advice, you should consider speaking with an experienced workers’ compensation lawyer who can address your questions and concerns.

Who is Eligible to Receive Workers’ Compensation Benefits?

Employers with three or more employees are required to purchase workers’ compensation insurance, so most employees across the state are eligible to receive benefits. As long as an injured worker was not intoxicated, under the influence of drugs, or participating in an illegal activity at the time of the workplace accident, his or her injuries will most likely be covered.

Are Independent Contractors Covered by Workers’ Compensation?

Unfortunately, independent contractors are not entitled to benefits under Georgia’s workers’ compensation laws. However, it can be difficult to determine whether a person qualifies as an employee or an independent contractor, so courts apply a series of factors when making these decisions, including:

  • Whether the employee signed an independent contractor agreement;
  • Whether the injured worker is paid on an hourly basis or is compensated at the completion of a job;
  • Whether the injured worker’s job is considered a part of the employer’s regular business or is viewed as an additional service;
  • Whether the worker supplies his or her own materials and tools;
  • Whether the employer decides how the work must be completed.

Fortunately, even when an employee does not receive a regular wage, he or she may still qualify as a covered employee. For example, elected officials, volunteers, and temporary workers are all considered covered employees for purposes of collecting workers’ compensation.

Who is Not Eligible to Receive Benefits?

Aside from independent contractors, Georgia law also exempts a number of employees from workers’ compensation coverage, including:

  • Federal employees;
  • Railroad employees;
  • Farmers;
  • Domestic workers;
  • Licensed real estate salespeople; and
  • Sports officials, including umpires and referees, unless they are employed by an organization that sponsors sports events.

However, just because an occupation is not specifically covered under state law, does not mean that workers are barred from recovery after a workplace injury, as many employers voluntarily choose to provide workers’ compensation for their employees. Further, some occupations are covered by their own compensation programs. Federal employees, for example, can receive medical benefits and wage replacement under the Federal Employees’ Compensation Act.

What Benefits can an Injured Employee Receive?

Under Georgia’s workers’ compensation laws, injured employees have the right to receive medical, income, and rehabilitation benefits. This means that injured workers can receive compensation for doctor and hospital bills, as well as rehabilitation costs, medications, and physical therapy. In addition to these costs, injured employees can also receive weekly income benefits in an amount that is equal to two-thirds of their average weekly wage. For injuries that are not totally disabling, employees can collect these benefits for up to 400 weeks. Finally, employees who sustain catastrophic injuries at work have the right to collect vocational rehabilitation benefits, which involves strengthening an employee’s work skills. Typical vocational rehabilitation includes:

  • On the job training;
  • Job application and resume services;
  • Educational programs;
  • Interview coaching;
  • Career counseling; and
  • Education and tuition payments.

This type of training can be crucial to helping injured workers learn new skills, while also enabling them to find new employment.

What Should I do if My Claim is Denied?

Unfortunately, hundreds of valid workers’ compensation claims are denied every year, often as a result of one of the following:

  • A failure to file a claim within a month of sustaining an injury;
  • A failure to submit the necessary paperwork;
  • A failure to prove that an injury occurred during the course of employment;
  • The employer disputes the claim; or
  • The State Board of Workers’ Compensation (SBWC) decided that the claimant’s injury was not severe enough to justify benefits.

Claimants whose claims have been denied have the right to appeal the decision by requesting a hearing or mediation with the SBWC. If mediation is unsuccessful, the SBWC will schedule a formal hearing, where the SBWC will hear evidence concerning the claimant’s injury. This requires the submission of medical records and written briefs, as well as expert and eyewitness testimony. If, after review, a judge denies the appeal, the claimant has 20 days to file another appeal with the Appellate Division.

The Appellate Division usually decides cases based on written arguments, and in some situations, oral arguments. However, no new evidence can be submitted at this time. Those whose claims are denied a third time can file an appeal with a state court, although these courts usually defer to the Appellate Division’s decision unless there is clear evidence of error.

How Long Will I Receive Benefits?

Injured employees who sustained non-catastrophic injuries on the job can collect benefits for up to 400 weeks. Those whose injuries qualify as catastrophic, however, may be eligible to collect benefits for the rest of their lives. Finally, even when injured workers return to work, they could still continue to receive benefits if they have been forced to accept lower paying employment as a result of their injuries. Injured workers will be eligible to receive these reduced benefits for up to 350 weeks.

Call Today to Schedule a Free Case Evaluation With a Workers’ Compensation Attorney in Forsyth County

If you were hurt at work and need help navigating the state’s complex workers’ compensation laws, please contact a member of the legal team at the Spillers Law Firm by calling (678) 208-0800 and setting up a free strategy session with an experienced Forsyth County workers’ compensation lawyer.

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